An Effective Model of Prison-Based Treatment for Drug-Involved Offenders

A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status-incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. The results support the effectiveness of a multistage therapeutic community model for drug-involved offenders, and the importance of a work release transitional therapeutic community as a component of this model.

Introduction

Drug Use and Crime

The linkages between drug abuse and crime have been well documented. Over the past 2 decades, both the National Institute on Drug Abuse and the National Institute of Justice have funded a number of major studies to generate better understandings of the drugs and crime connection and the linkages between the two phenomena The research has yielded a number of interesting findings. For example, in extensive follow-up studies of addict careers in Baltimore, the researchers found high rates of criminality among heroin users during those periods when they were active users and markedly lower rates during times of nonuse (Ball et al. 1983). Studies conducted in New York City concerning the economics of the drug-crime relationship documented the wide range of heroin usage rates among addicts and the clear correlation between the amount of drugs used and amount of crime committed (Johnson et al. 1985). Miami-based research, furthermore, demonstrated that the amount of crime committed by drug users was far greater than anyone had previously imagined, that drug-related crime could at times be exceedingly violent, and that the criminality of street drug users was far beyond the control of law enforcement (Inciardi 1979, 1992; Inciardi and Pottieger 1986, 1991, 1994). Other research has reported similar conclusions (Speckart and Anglin 1986; Anglin and Hser 1987). Together, the overall findings suggest that, although the use of heroin, cocaine, and other illegal drugs does not necessarily initiate criminal careers, drug use does intensify and perpetuate criminal activity. That is, street drugs seem to lock users into patterns of criminality that are more acute, dynamic, unremitting, and enduring than those of other offenders.

The presence of substance abusers in criminal justice settings has also been well documented. A concomitant of drug-related criminality and the war on drugs of the 1980s and early 1990s has been the increased numbers of drug-involved offenders coming to the attention of the criminal justice system (Inciardi 1993; Inciardi et al. 1996). In fact, it has been reported that perhaps two-thirds of those entering state and federal penitentiaries have histories of substance abuse (Chaiken 1989; Chavaria 1992; Leukefeld and Tims 1992). This suggests that criminal justice settings offer excellent opportunities for assessing the treatment needs of drug-involved offenders, and for providing treatment services in an efficient and clinically sound manner (Reno 1993; Hawk 1993).

Drug Treatment for Offenders

Many clinicians and practitioners have felt that the therapeutic community (TC) is one of the most viable forms of treatment for drug-involved offenders, particularly those whose criminality results in incarceration (Leukefeld and Tims 1988, 1992; Tims et al. …

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